Treatment of osteopenia and osteoporosis in anorexia nervosa: a systematic review of the literature.
OBJECTIVE
To systematically review the evidence supporting treatment of osteopenia and osteoporosis in patients with anorexia nervosa (AN).


METHODS
We identified controlled clinical studies of interventions for low bone mass in AN via searches of MEDLINE; the Cochrane Library; EMBASE; PsycINFO; and cumulative index to nursing and allied health literature. Outcomes of interest were changes in bone mineral density and fracture incidence.


RESULTS
Six randomized controlled trials (RCTs) and two cohort trials examined five classes of medical therapy on bone mineral density outcomes. One RCT of bisphosphonates showed no benefit and a second flawed RCT showed some benefit; one RCT showed a benefit of insulin-like growth factor-I; none of the five trials evaluating estrogen therapy showed benefit.


CONCLUSIONS
Although patients with AN are often losing bone mass when they should be optimizing bone growth, there is no good evidence to guide medicinal interventions. Therefore, early detection and weight restoration are of utmost importance whereas ongoing trials define effective therapies.
Mehler
Philip S
PS
Department of Internal Medicine, Denver Health Medical Center, Denver, Colorado 80204, USA. pmehler@dhha.org
MacKenzie
Thomas D
TD
D000856:Anorexia Nervosa / Q000503:physiopathology*; D015519:Bone Density / Q000187:drug effects* / Q000502:physiology; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001851:Bone Diseases, Metabolic / Q000188:drug therapy* / Q000209:etiology; D002118:Calcium / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D004967:Estrogens / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D015444:Exercise / Q000502:physiology; D050723:Fractures, Bone / Q000517:prevention & control; D020249:Hormone Replacement Therapy; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000627:therapeutic use; D010024:Osteoporosis / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome; D015430:Weight Gain / Q000502:physiology
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D004967:Estrogens; D007334:Insulin-Like Growth Factor I; D002118:Calcium